1Department of Internal Medicine/Nephrology, Ziekenhuis Groep Twente, Almelo, the Netherlands.
2Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Diabetes Care. 2022 Jan 1;45(1):35-41. doi: 10.2337/dc21-1211.
To study the prospective association between dietary protein intake and renal function deterioration in patients with type 2 diabetes (T2D).
Prospective analyses were performed in data of 382 patients of the Diabetes and Lifestyle Cohort Twente (DIALECT) study. Dietary protein intake was determined by the Maroni equation from 24-h urinary urea excretion. Renal function deterioration was defined as need for renal replacement therapy or a persistent increase of ≥50% in serum creatinine. Cox proportional hazards models were used to calculate hazard ratios (HRs) for the association between dietary protein intake and renal function deterioration. Threshold levels represent the dietary protein intake at which there was a significantly increased and reduced hazard of renal function deterioration.
Renal function deterioration occurred in 53 patients (14%), with a median follow-up duration of 6 (interquartile range 5-9) years. Mean dietary protein intake was 91 ± 27 g/day (1.22 ± 0.33 g/kg ideal body weight/day). Dietary protein intake was inversely associated with renal function deterioration (HR 0.62 [95% CI 0.44-0.90]). Patients with an intake <92 g/day had an increased hazard for renal function deterioration (HR 1.44 [95% CI 1.00-2.06]), while patients with an intake >163 g/day had a decreased hazard for renal function deterioration (HR 0.42 [95% CI 0.18-1.00]). Regarding dietary protein intake per kilogram body weight, patients with an intake <1.08 g/kg/day had an increased hazard for renal function deterioration (HR 1.63 [95% CI 1.00-2.65]).
In patients with T2D, unrestricted dietary protein intake was not associated with an increased hazard of renal function deterioration. Therefore, substituting carbohydrates with dietary protein is not contraindicated as a part of T2D management, although it may have a positive effect on body weight while minimizing loss of muscle mass.
研究 2 型糖尿病（T2D）患者膳食蛋白质摄入量与肾功能恶化的前瞻性关联。
对糖尿病和生活方式队列特温特研究（DIALECT）数据中的 382 例患者进行前瞻性分析。膳食蛋白质摄入量通过 24 小时尿尿素排泄量的 Maroni 方程确定。肾功能恶化定义为需要肾脏替代治疗或血清肌酐持续增加≥50%。使用 Cox 比例风险模型计算膳食蛋白质摄入量与肾功能恶化之间的关联的风险比（HR）。阈值水平代表膳食蛋白质摄入量，在此摄入量下肾功能恶化的风险显著增加或降低。
53 例患者（14%）发生肾功能恶化，中位随访时间为 6 年（四分位间距 5-9 年）。平均膳食蛋白质摄入量为 91±27g/天（1.22±0.33g/kg 理想体重/天）。膳食蛋白质摄入量与肾功能恶化呈负相关（HR 0.62[95%CI 0.44-0.90]）。摄入量<92g/天的患者肾功能恶化的风险增加（HR 1.44[95%CI 1.00-2.06]），而摄入量>163g/天的患者肾功能恶化的风险降低（HR 0.42[95%CI 0.18-1.00]）。关于每公斤体重的膳食蛋白质摄入量，摄入量<1.08g/kg/天的患者肾功能恶化的风险增加（HR 1.63[95%CI 1.00-2.65]）。
在 T2D 患者中，无限制的膳食蛋白质摄入与肾功能恶化的风险增加无关。因此，用膳食蛋白质替代碳水化合物作为 T2D 管理的一部分并非禁忌，尽管它可能对体重产生积极影响，同时最大限度地减少肌肉质量的损失。
